Winther Kristian Hillert, Papini Enrico, Attanasio Roberto, Negro Roberto, Hegedüs Laszlo
Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark.
Department of Endocrinology and Metabolism, Ospedale Regina Apostolorum, Rome, Italy.
Eur Thyroid J. 2020 Feb;9(2):99-105. doi: 10.1159/000504781. Epub 2020 Jan 14.
To investigate clinical practice regarding the use of selenium supplementation in patients with Hashimoto's thyroiditis (HT) among members of the European Thyroid Association (ETA).
ETA members were invited to participate in an online survey investigating the use of selenium supplementation across the spectrum of benign thyroid diseases. Of 872 invited members, 242 (28%) completed the survey. After exclusion of basic scientists and non-European members, survey data from 212 respondents were eligible for further analyses. Responses from 65 (31%) individuals who did not at all recommend selenium, or only considered its use in the setting of a clinical trial, were not included in the final analysis of survey data from 147 respondents.
While only a minority of respondents (29 of 147, 20%) stated that the available evidence warrants the use of Se in patients with HT, a statistically significant majority (95 of 147; 65%, < 0.001) used Se occasionally or routinely. Se was predominantly recommended for patients with HT not receiving LT4 (102 of 147; 69%) to reduce circulating thyroid autoantibody levels. Very few respondents routinely recommended Se to pregnant patients with HT.
A minority of responding ETA members stated that the available evidence warrants the use of Se in HT, but a majority recommended it to some extent, especially to patients not yet receiving LT4. This is questionable, and selenium is not recommended to patients with HT according to current ETA guidelines. Ongoing and future trials may lead to the reversal of current medical practice.
调查欧洲甲状腺协会(ETA)成员中关于桥本甲状腺炎(HT)患者补充硒的临床实践情况。
邀请ETA成员参与一项在线调查,该调查旨在研究在各种良性甲状腺疾病中补充硒的使用情况。在872名受邀成员中,242名(28%)完成了调查。排除基础科学家和非欧洲成员后,来自212名受访者的调查数据符合进一步分析的条件。65名(31%)完全不推荐使用硒或仅考虑在临床试验中使用硒的受访者的回答未纳入对147名受访者调查数据的最终分析。
虽然只有少数受访者(147名中的29名,20%)表示现有证据支持在HT患者中使用硒,但统计学上显著多数(147名中的95名;65%,<0.001)偶尔或常规使用硒。硒主要推荐给未接受左甲状腺素(LT4)治疗的HT患者(147名中的102名;69%),以降低循环甲状腺自身抗体水平。很少有受访者常规推荐硒给患有HT的孕妇。
少数回应的ETA成员表示现有证据支持在HT中使用硒,但大多数成员在一定程度上推荐使用,特别是对尚未接受LT4治疗的患者。这是有问题的,根据当前ETA指南,不建议HT患者使用硒。正在进行的和未来的试验可能会导致当前医疗实践的改变。